From the ICU to the morgue

Hi!

Team CRI have just launched Swarajya! Check it out!

AAP’s vision for healthcare reform will saddle India with a sclerotic, expensive, exchequer funded healthcare system that will be unaccountable to the public and take India’s outcomes from bad to worse.

In its recently released vision document, the Aam Aadmi Party (AAP) has outlined its vision for healthcare transformation in India. Summarized into six pithy points, the vision should be a cause for significant concern for healthcare leaders and professionals.

The brief section begins with a strong assertion: to substantially increase spending, which by itself seems a laudable goal.

However the devil is in the details; or the lack of it. Across the agenda items, in true babu-style, the focus is singularly on throwing money at the problem or on creating employment. Never once do healthcare goals, outcomes such as quality of care, patient safety, efficiency and economy find any mention.

By the time you read the second point the goal becomes clear: creating a massive socialised healthcare system, planned (from ‘commanding heights’) by the government, built using taxpayer money and run using taxpayer funds. Never mind that after 70 years of independence, public hospitals have universally becomes symbols of decay and apathy, the message is clear: while socialised healthcare may have failed in India, the AAP will not stop trying with the same model – with our money.

The reasons for the failure of India’s public hospitals (in general) are many: public hospitals are governed using management principles and employment norms that are designed to provide employment, not deliver patient care. As a result, they are grossly inefficient and employ far more people than they need to – typically, over 60% of staff at public hospitals do little in terms of patient care. Public hospitals also consistently struggle to obtain equipment and services at anything resembling good prices; they struggle to achieve basic standards in management and are fighting a losing battle in retaining talent. Finally, due to these and other conditions, public sector hospitals of all standards struggle to employ physicians. Several studies have shown that vacancy rates for physicians in public hospitals across the country can be as high as 60%. Even a national leader like AIIMS struggles to fill its teaching posts!

Despite these known shortcomings, the AAP manifesto does not talk about fixing any of them. Though a perfunctory nod to increasing accountability has been made, concrete steps – such as fixing rotten labour laws, bringing in a semblance of a meritocracy, fixing accountability levels, bringing in independent regulation in public healthcare, enabling public hospitals to adopt modern management principles for employment — find no mention anywhere in the entire document. In the absence of these reforms, the AAP’s bold plans for aggressively investing in healthcare are likely to end up wasting public money in constructing empty buildings with no care givers – and hence no care.

The AAP continues in its bureaucratic, input obsessed ’employment generation’ frame of reference – for example with reference to health workers. Despite this heart-warming focus on employment and empowerment of women, nowhere in the vision does the AAP conceptualize unshackling education from the clutches of the license Raj.

Finally, however, the AAP does note that cuts and questionable economic practices should not be tolerated. But, the document at least, does not show any understanding of the root causes of these practices: namely information asymmetry between doctors and patients, a total lack of focus on outcomes and virtually no real legal protection to customers.

Since it does not outline any solutions to fix these real, painful, substantive issues, one can only assume a resort to Delhi-style vigilantism; a solution worse than the crime.

In sum, the AAP’s healthcare vision is a scaled up version of the current socialised, license Raj in healthcare. A choice for which India has paid a terrible price.

In the author’s view, the current vision is unfortunate.

Real game changing reforms — such as moving the government from running hospitals to paying for care against prescribed norms and standards; mandating declaration of outcomes (clinical and financial); enabling patients to choose their providers by making funding follow the individual; unshackling the sector from red tape; and enabling technology and innovation to transforming healthcare — have been given a miss.

What we have is just more of the same. The AAP, it would seem, would like people to believe that its ‘good’ version of socialised license raj will outperform the ‘bad’ socialised license raj we have lived with.

Given what is possible; indeed given what is necessary, the AAP’s lacklustre healthcare vision earns it a D minus.

AAP proves that it is the B team of Congress and will do what Sonia’s NAC did to welfare.

Chacha Choudhary

Haha. I love how well you have understood the health care sector in India. I must convince Sabu to apply to Harvard – if you can get in, surely he can too!

Joseph Anton

It seems to me the author has political issues with AAP’s rise to prominence rather than technical disagreements with the manifesto. His grievances with AAP appear pre-conceived and barely connected to what AAP is actually saying in the document.

The author, for some strange reason, arbitrarily allots differential weightage to what is actually said in the document – dismissing as “perfunctory” the statement “putting in place accountability mechanisms in public health system” (emphasis mine), while practically writing the entire article based on the preceding part, which has fewer actual words: “Make large scale investment in public hopsitals”. Since the entire credo of AAP as a party is accountability in Indian public life, it requires an assumption of extreme stupidity (or partisanship) in his audience for the author to dismiss that very important part of the manifesto as perfunctory!

Once you see through the trick of selectively differential weightage to different parts of the AAP manifesto, the author’s main argument is lost and the article completely unravels. (1/2)

Joseph Anton

(2/2)
Also, the author’s faith in private enterprise as the optimal healthcare solution is touching if naïve. Comparing the public healthcare systems (‘socialist’) in Canada and UK with that of the majorly private healthcare in US is revealing. The best charitable commentatorsn can say of the US healthcare delivery system is that it is ‘broken’; uncharitablemones call it an outright scam. While the US hosts some of the leading hospitals and academic medical centers in the world and is a hotbed of innovation, public delivery of healthcare services in that country is at the bottom of the developed world – below Canada, UK and most others, even lower than communist Cuba!

Closer home, another fine example of how private enterprise is not always panacea is the Indian drug industry. Its leading proponent Ranbaxy pled guilty on seven federal *criminal* counts in the US, admitting to selling adulterated drugs in the US with intent to defraud , and paid fines amounting to US $500 million! One shudders to think what Ranbaxy has been selling its Indian customers at home, given non-existent regulations and regulators and politicians who are easily bought!

J Anton

(CRI moderators – I am seeing a prompt that my regular Disqus account is being blocked by a CRI moderator. I would appreciate it if you would not indulge in blocking for only political disagreements. Thank you)

2/2 – reposted from alternate account.

Also, the author’s faith in private enterprise as the optimal healthcare solution is touching if naïve. Comparing the public healthcare systems (‘socialist’) in Canada and UK with that of the majorly private healthcare in US is revealing. The best charitable commentators can say of the US healthcare delivery system is that it is ‘broken’; uncharitable ones call it an outright scam. While the US hosts some of the leading hospitals and academic medical centers in the world and is a hotbed of innovation, public delivery of healthcare services in that country is at the bottom of the developed world – below Canada, UK and most others, even lower than communist Cuba!

Closer home, another fine example of how private enterprise is not always panacea is the Indian drug industry. Its leading proponent Ranbaxy pled guilty on seven federal *criminal* counts in the US, admitting to selling adulterated drugs in the US with intent to defraud , and paid fines amounting to US $500 million! One shudders to think what Ranbaxy has been selling its Indian customers at home, given non-existent regulations and regulators and politicians who are easily bought!

J Anton

Update Feb 26, 2014: Nice irony this – so CRI itself is resorting to censorship! They are blocking me from posting new comments on the site from my usual Disqus profile.

You may disagree with the politics behind my comments, but you cannot ever call them abusive, obscene or out of place. This is not how you should respond to civil, if dissenting, arguments. It is disappointing that a forum that positions itself as a center-right market place of ideas, instead of responding to a technical counter-argument on a health care article, resorts to blocking me across the board.

J Anton

Hope this post also does not vanish into the “Awaiting moderation” abyss!

J Anton

Hope the above does not vanish into the “Awaiting moderation” abyss!

Joseph Anton

test post

SanMissar

While “Accountability in Indian Public Life” is a laudable goal in itself, it is rather impractical to expect this to be the one stop solution to all the problems that the country faces. India’s dalliance with the public healthcare system has delivered the exact same results as its dalliances with other socialistic principles applied elsewhere, abject failure. That is what the author has a beef with. I don’t think the author has apolitical issue rather an issue of economical and practical viability.

Jishnu

AAP being well known for lies and fraud, going by manifesto is only done by fools or their co-fraudsters.

Joseph Anton

While public healthcare systems have some issues, private systems have numerous problems too. The ‘socialist’ single payor systems in Canada and UK – as has been frequently recounted- beat the extremely expensive private US system on most healthcare outcome measures!

Closer home, the success story that is the Indian pharma industry: Ranbaxy recently pled guilty to multiple *criminal* charges in US federal court for knowingly adulterating drugs supplied to the US. One shudders to

SanMissar

Let’s not compare systems adopted in different countries with India. Canada and UK do not face the demographic, logistical and financial challenges that India does.

Joseph Anton

Only making the point that public versus private systems are not necessarily the determinative factors in healthcare outcomes, unlike what the author says – intent, execution and oversight more important.

AAP, of all available parties, appears best manned and equipped to deliver precisely that.

SanMissar

Its not a political debate. Irrespective of which party comes to power, the actual implementation will be done by the bureaucrats. The political parties are limited in their role to giving a very generic blueprint. I am not sure how AAP is ‘equipped’ or ‘manned’ for this purpose but then it is not a question of politics. Healthcare reforms have broader ramifications on the economy and unless an expert lends his/her two cents on this, we will all be beating around the bush. The author here is a man in this domain and if he has a certain opinion, it should be respected and not dragged down as politically biased. You may not necessarily agree with it but you must respect it. While AAP as an political idea is not bad in itself but the blind acceptance that each word spoken from its stable is gospel is a worrying trend. Attacking anyone that has a contrary opinion is rather unfortunate.

CracklingWit

We have seen how AAP workers controlled government hospitals during their miserable 49 days (mis)governance. (pulling out doctors from operation theaters, forcing doctors to give medicines what these AAPtards think is right etc) Only gullible can be easily trapped with their cheap tricks and hallow promises.

http://centreright.in Amar

I seem to be able to see you comments! Email us if you comments are still stuck!

Joseph Anton

“The political parties are limited in their role..”

Unfortunately, you are trying to have it both ways. If the above was the only truth out there, this entire article is moot.

“The author here is a man in this domain and if he has a certain opinion, it should be respected…”

The reference to ‘expertise’ to defend a bad argument is a common one, but still faulty. Even so, I do not consider a trainee at Mass General or BWH (a.k.a. Harvard fellow) to be a ‘domain expert’ in anything, much less in formulating healthcare policy – with all due respect.

Joseph Anton

For some reason, I am not able to submit one particular post (2/2 of an earlier comment – which is as bad or good as my usual comments, and has nothing in particular that should be automatically flagged ).

It goes into “awaiting moderation” immediately, and does not see light of day. I initially worried I was being actively blocked, but am happy to be wrong, since I am able to post otherwise.

Thanks!

Sekhars

AAP clearly lacks vision, planning and doesn’t learns from the most successful models of governance exist or tested in our own setting.

The only good thing about AAP is that their intentions may be good though execution is what they just don’t know. They need to bring people who can execute their vision. But if you have people like Prashant Bhushan who can’t lead from front and have tendency to run away in dire or difficult circumstances your future is doomed.

Sekhars

India has much larger private system than many countries.

Our Govt doesn’t spent enough on healthcare and there are no plans or visions to improve quality and it is a un-managed mess. We have no ethical standards, have major issues with medical education system which is completely broken and in disarray. Many major medical institutions lacks basic standards, there are no oversights and concept of a system to ensure checks. Most medical facilities are un-regulated and do not have standard of care which is not even established by regulators.

Sekhars

Adheet
Your assumption that public healthcare in India has failed and private healthcare is working simply incorrect.

Most private facilities in India are un-regulated, are no better and still lacks standard of care. They are still poorly managed, involved in un-ethical practices and have provided no better care but trying to copy an american system which has many layers of regulation and under very close watch of many regulating agencies. You know how many physician lose medical license in US each day ? and how many lose in India for similar issues ? almost none. We have no regulation or enforcements.

Why one’ can’t argue that making a public system more efficient, improving regulation and oversight, ensuring the standard of care is developed and enforced won’t succeed when it succeeds in many socialist system- example Cuba, France and Canada.

RVenkatanarayanan

I am not surprised at the unfounded exaggerations in Adheet’s write-up. After all he is from Harvard. Has he ever gone in to a “public” hospital in India and asked the patients and doctors what is their view? What is this non-public “health care” he talks about? Private hospitals that are money-spinning machines? Has he ever gone in to any vaunted “private” hospital in India and checked out how many patients out of 100 are super-rich, rich, upper middle class, middle class,lower middle class and poor? The writer is batting for the so called health care consultants, private hospital money-makers and of course the rich in the country who drive to hospitals in Mercs.
I do not find any thing much wrong in what AAP says in principle, though I consider the Party comprises wooly-headed, inexperienced but well meaning men and women. After being in government for 35 years I would say: (i) Increase public health expenditure; (ii) go bottom up from Primary health easily accessible to the poor and the lower middle class, in creating infrastructure and medical personnel; (iii) increase the supply of para-medical personnel and general practitioners; (iv) tighten up accountability at every stage both among medical and non-medical personnel by putting systems in place; (v) get rid of political patronage and interference in running hospitals; (vi) get rid of the nonsensical policy called medical tourism; and lastly (vii) leave the “super-speciality stuff to the private sector and consultants like Adheet!
R.Venkatanarayanan

ManiV

I agree with you.. with such a stringent regulator like the FDA, if Ranbaxy could get away with Deliberate Drug Adulteration for any length of time, however small or large, we are in for huge surprises in the Indian context..

ManiV

Point 7 was a killer sir!

Adelmo

Well said. AAP neither has true intentions to provide any solutions to people’s problems nor it has ability for long haul in politics to achieve such high standards. They are here just for snatching power and enjoy their time playing shoot and scoot.

Kejriwal has proven track record of just that even while in IRS, later as NGO and now as failed CM. He has no real intention to develop India but only to spoil the existing system by raising hope of some impractical system which he will never put forward as his vision as he himself is a dogmatic persona.

Subscribe to our mailing list

Like us on Facebook

Categories

Categories

Recent Comments

gk: Are you running some university where you gave yourself '100' level knowledge rating? If you have s…

gk: >>>>>So what? words get added,changed and removed as time goes on You really do not h…

Sekar Devaraj: You have to study more, your knowledge level is "0". Please study and comeback to discuss here.…